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Heroin Addiction and Related Clinical Problems: 2022, 24, N3 (pages: 21 - 27)

Baclofen in the Treatment of Alcohol Withdrawal Syndrome in Opioid-Dependent Patients

Gibbons Z., McCarron P., Santlal K., McCarthy R., and Keenan E.

Summary: Background: Baclofen, a gammaminobutyric acid (GABA)-B agonist, has emerged as a possible treatment for alcohol withdrawal syndrome but no studies have documented whether it is effective in patients co-prescribed opioid agonist treatment (OAT). We carried out a study to assess its effectiveness and acceptance to patients for the treatment of alcohol withdrawal during alcohol detoxification in patients receiving OAT. Methods: This was a non-blinded single arm (active treatment) prospective trial carried out in a tertiary addiction clinic. Twenty-three patients agreed to participate in the study; 20 commenced the study and 17 completed it. All participants were prescribed OAT, met the ICD 10 criteria for alcohol dependence syndrome, were 18 years or older and were not actively psychotic. Participants attended daily during baclofen-assisted detoxification. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was used to identify withdrawal symptoms experienced by participants. Self-reported alcohol intake was obtained from each participant. Participant satisfaction was monitored using Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4. Intention to treat analyses were conducted to assess effectiveness of baclofen and participant satisfaction with baclofen. Results: Among 20 participants with a mean (standard deviation) age of 37.6 (6.4) years, the median (interquartile range) alcohol intake per day prior to detoxification with baclofen was 26.5 (20.8 to 37.3) and this declined to 6.0 (3.9 to 8.0) units over the course of the study. There were also substantial reductions in median CIWA-Ar for all participants. Patient satisfaction scores were high on all scales of the TSQM. Conclusions: The evidence from the current study suggests that baclofen is effective in preventing debilitating withdrawal symptoms in opioid-dependent patients who engage in harmful alcohol consumption and who are engaging in alcohol detoxification. Baclofen is also an acceptable treatment for alcohol withdrawal symptoms in this group of patients. Baclofen may therefore offer an alternative in the treatment of alcohol withdrawal.